Aim: People with speaking disabilities have equal rights to functional interaction and communication as people without disabilities. These rights actualize only through the actions and skills of more able communicators. Guiding staff and family members is an important part of every speech and language pathologist's (SLP) job, especially if the client has severe learning disability. However, many SLPs experience guiding difficult and the results of staff communication training have been unsatisfactory. There are different models that can be used to help the process of indirect speech and language therapy. One of them is called Intensive interaction (II). Its role in enhancing interaction skills of more able communicators has only been studied a little. The purpose of this study is to find out if II is a meaningful approach to carry out indirect speech and language therapy. The aim was to find out if and how the interaction skills of a staff member change during an II process. The aim was also to figure out how she saw the significance of II. Methods: This research data were collected in the Communication and Technology Centre Tikoteekki of the Finnish Association on Intellectual and Developmental Disabilities. The data were collected during an II process that took place in 2014 and 2015 in a residential unit for people with learning disabilities. This study had two participants, one of whom was a resident with multiple learning and speaking disabilities, and the other one a staff member. The video material was composed of 14 interaction videos between the resident and the staff member, and one video of guidance discussion between the staff member and the mentoring SLP in the end of the process. The data were analysed according to the themes arising from the data, by mostly qualitative means. The changes in interaction skills were described with different tables and transcriptions. The guidance discussion was transcribed and analysed according to inductive analysis. Results and conclusions: The interaction style of the staff member became more sensitive and present. That change manifested through improvements in four elements of interaction: distance from the interaction partner, touching, quality and quantity of vocalization and tasklessness of interaction. The staff member saw II as a meaningful approach, especially for herself as an employee, but also for her interaction partner with multiple disabilities and more generally. These results suggest that II is a meaningful and effective means of mentoring significant others to become more sensitive, skillful and able interaction partners for persons with severe speaking disabilities. Additionally this study gives premises for further research on II and indirect speech and language therapy. In light of this research II is also important on societal level.

Aphasia is often a chronic impairment. Regaining the premorbid language function is rare. Anomia is the most common residual disorder once the aphasia has stabilized. Earlier studies indicate that transcranial magnetic stimulation (rTMS, repetitive Transcranial Magnetic Stimulation) together with intensive speech therapy improves the outcome of the language rehabilitation. The aim of the current study was to find out what kinds of quantitative and qualitative changes occur in the participants' ability to name noun and verb pictures that were shown during the rTMS/sham-rTMS protocol. All of the participants received two weeks of either rTMS or sham-rTMS treatment and after a one-week break another two weeks of either rTMS or sham- rTMS treatment together with intensive group speech therapy (ILAT, Intensive Language Action Therapy). This is a multiple case study with six participants that have chronic expressive aphasia. The first two groups of a larger study were selected into this study. Group 1 (n=3) received 1Hz- rTMS therapy and group 2 (n=3) received sham-rTMS. rTMS was given to the right hemisphere on the pars triangularis area. Every participant named the same amount of action and object pictures during the rTMS/sham-rTMS treatment. Namings were analysed with a rating system derived for the current study. Each participant received intensive group speech therapy in the latter two-week part of the intervention. Language testing was conducted before, during and three months after the intervention. The naming abilities in all participants seemed to improve in both noun and verb series during the rTMS/sham-rTMS treatment and language tests. Results of the follow-up testing suggest that the positive results are long lasting. The results of this study are promising, even though the amount of participants is too small to draw further conclusions. This study brings positive evidence and reason for further research on the effectiveness of aphasia therapy.

Goals. Event schema, also known as a script, contains information about a structure of a particular event; about the sequences of events and their temporal order. With the information the scripts contain, one can anticipate and plan for future events and actions. People with traumatic brain injury (TBI) can have difficulties in the verbal planning of actions. Previous international research has shown that the scripts produced by people with TBI contain fewer actions central to the schema, than scripts produced by healthy control subjects. The aim of this study is to examine what kind of scripts Finnish speaking subjects with TBI and their healthy control subject counterparts generate in a script generation task consisting of eight scripts. This study also examines whether the script type has influence on the features of the generated scripts. Methods. Fifteen subjects with TBI and fifteen healthy control subjects participated in the study. The researcher collected the research material during the spring and summer 2015. The research material consisted of the scripts generated by the subjects and control subjects, as well as the results of the control tasks (Boston Naming Test, Rapid Automatized Naming Test, semantic and phonemic fluencies). The subjects were asked to generate event schemas for eight everyday tasks belonging to four schema categories. The categories were 'open high frequency' (go shopping, go for a walk), 'open low frequency' (apply for a job, go on a vacation), 'closed high frequency' (make coffee, brush teeth), and 'closed low frequency' (go to a doctor, go to a restaurant). Closed scripts are related to events where the actions involved in their execution are well established and tightly related to each other. Open scripts are less structured and have loose connections between the actions involved. High and low frequency scripts differ on how frequent the event is. Time given for generating each script was 60 seconds. The scripts were scored for the total number of events produced, the number of event repetitions, the informativeness of the script, and the meaningfulness and the centrality of the events. The results of the qualitative analysis were displayed in a statistical form and analyzed with the non-parametrical Mann-Whitney U -test. Results and conclusions. The results showed that the scripts produced by the subjects with TBI were less informative and contained less actions than the scripts produced by the healthy control subjects, regardless of the script type. Closed scripts were found to be more informative than open scripts, and the subjects produced more actions to the closed than to the open scripts. When the high and low frequency scripts generated by the subjects with TBI were examined, no significant difference was found between the two script types. The results of this study can be explained by the disturbances in executive functions, and disturbances in the working memory as well as the episodic memory, all of which can affect the subject's ability to produce a coherent story and recall actions belonging to a certain event.

Active engagement in interactions is crucial for the development of identity, social competence, and cognitive abilities. For children with severe speech impairment (SSI) who have little or no intelligible speech, active participation in conversations is challenging and can be critical for their social inclusion and participation. The present study investigated the conversational patterns emerging from interactions between children with SSI who use aided communication and typically speaking conversation partners (CPs) and explored whether active participation was different in interactions with different numbers of partners (dyadic versus multi-person interactions). An unusually large multilingual dataset was used (N= 85 conversations). This allowed us to systematically investigate discourse analysis measures indicating participation: the distribution of conversational control (initiations versus responses versus recodes) and summoning power (obliges versus comments). The findings suggest that (i) conversations were characterized by asymmetrical conversational patterns with CPs assuming most of the conversational control and (ii) multi-person interactions were noticeably more symmetric compared to dyadic, as children's active participation in multi-person interactions was significantly increased. Clinical implications and best practice recommendations are discussed.

Aims. Improved quality of life is considered to be the overarching goal of aphasia rehabilitation based on the social model. Around the world research has been done on the factors that affect the quality of life with people with aphasia. Different kinds of structured quality of life measurements have been developed that aim to enable people with aphasia to self-report quality of life. In Finland research on the subject has been scarce. The aim of this study was to explore the views of Finnish speech and language therapists (SLT) on the quality of life in aphasia rehabilitation and the prevailing clinical practices as well as to investigate how they compare internationally. Methods. For the purposes of this study a questionnaire composed by the Aphasia Committee of the International Association of Logopedics and Phoniatrics (IALP) was translated into the Finnish language. 64 questionnaires were filled out. The Finnish data was analysed by using descriptive statistics and content analysis. The data collected in this survey formed Finland's part of an international survey conducted by IALP, which allowed the comparison between the Finnish and international results. The international survey contained 581 respondents from 16 countries including Finland. The Finnish and international data were compared by cross tabulation and Chi Squared -test. Results and conclusions. According to Finnish SLTs it is important to incorporate into practice with aphasia several quality of life domains, such as communication, affect, in/dependence, social activities, personal outlook and in addition to consider life satisfaction, social support and environment. Almost all of the Finnish SLTs used interviewing as their primary method for assessing the quality of life, only four used structured quality of life measures. Internationally there were mentioned many different structured quality of life assessments. This study indicates explicitly that there is a demand for structured quality of life assessments in Finland. The results can be applied in developing education, research and clinical practice.

Aims. The purpose of this single-case study was to investigate the effects of intensive tablet-based treatment in overall language performance level and in reading and writing processes in mild aphasia. The communicative effectiveness and task performances on the tablet software were also studied. The tablet software included tasks where semantic, syntactic and phonological processing were required; written naming, sentence writing and reading comprehension. Previous studies have indicated improvements in language skills after computer-based treatment (Katz & Wertz, 1997; Wade, Mortley & Enderby, 2003). Especially reading and writing skills can be treated by the computer-based softwares (Katz, 2008). Methods & Procedures. In this single subject research the ABA design was used. The participant in this study was a 47 year old man who had a stroke 2.5 years earlier. He had a mild chronic aphasia with difficulties in writing, reading and naming. The data of this study was formed by linguistic tests and by a self-assessment method as the participant evaluated his communicative effectiveness (CETI). The methods used in the analysis of written and read narratives included assessing rate, authenticity and the types of errors. The analysis of written narratives also included assessing word classes and type-token –ratio. Based on the data by the tablet-based software the rate and the share of errors of task performances were assessed. Results & Conclusions. Based on the Western Aphasia Battery (WAB) results, the severity of the aphasia decreased but the change was not clinically significant. Naming improved but the change wasn't stable until the follow-up. The participant showed positive development in his written and reading production; he made less spelling and reading errors after the treatment. At the same time reading and writing processes became slower. The share of lexical verbs, adjectives, pronouns and numerals increased in written narratives. The communicative effectiveness improved. The task performance on the tablet software was faster during the fourth week compared to the first week. Also the amount of incorrect performances decreased or remained the same. Based on the results, an intensive self-monitored tablet-based language treatment was effective to the subject.

Aim. In conversation mutual understanding is achieved through co-operation of each participant. Mutual understanding might be more at risk in conversation where one or more participants use augmentative and alternative communication (AAC). To be able to support people who use AAC and guide their communication partners, interventionists should understand how communication problems and challenges are being resolved in a natural conversation. The aim of this study is to describe how participants orient to problems in AAC conversation. Conversation partners' other-initiations of repair and the problems these initiations indicate are being studied. Method. The database consists of two videotaped conversations where one aided speaker, a 15-year-old boy with cerebral palsy, talks with a speech-language pathology student (conv 1) and with his speech-language pathologist (conv 2). The data was originally videotaped for speech therapy follow-up. Problems and how they were managed were studied using conversation analysis (CA) and one of its basic organizations, repair organization. CA enables detailed examination of natural interaction. Results and conclusions. Almost every other-initiation of repair fell upon the problems in aided speaker's turn and were initiated by conversation partners. These problems related broadly to speech understanding, more precisely to understandability of utterances. No problems of hearing were raised. Reasons underlying the trouble sources were most often conversation partner's difficulty in understanding the meaning of aided speaker's whole turn or part of a turn, extra words or other mistakes in selecting symbols, or vague reference. From all the conversation partners' other-initiations of repair interpretative means, candidate understandings, were used most often and the initiations of repair were at the same time pointing a problem and trying to resolve it. Interpretation seemed to be explicitly on display in both conversations. It was used to show understanding of AAC turn and to initiate repair. In order to be able to understand how to support AAC users' human agency and active participation in conversation, more research needs to be done on different conversations.

Goals. Specific language impairment (SLI) has a negative impact on child's speech and language development and interaction. Disorder may be associated with a wide range of comorbid problems. In clinical speech therapy it is important to see the child as a whole so that the rehabilitation can be targeted properly. The aim of this study was to describe the linguistic-cognitive and comorbid symptoms of children with SLI at the age of five, as well as to provide an overview of the developmental disorders in the families. The study is part of a larger research project, which will examine paths of development and quality of life of children with SLI as young adults. Methods. The data consisted of patient documents of 100 5-year old children, who were examined in Lastenlinna mainly at 1998. Majority of the subjects were boys, and children's primary diagnosis was either F80.1 or F80.2, which was most common, or both. The diagnosis and the information about the linguistic-cognitive status and comorbid symptoms were collected from reports of medical doctors and experts of other fields, as well as mentions related to familiality. Linguistic-cognitive symptoms were divided into subclasses of speech motor functions, prosessing of language, comprehension of language and use of language. Comorbid symptoms were divided into subclasses of interaction, activity and attention, emotional and behavior problems and neurologic problems. Statistical analyses were based mainly on Pearson's Chi Square test. Results and conclusions. Problems in language processing and speech motor functions were most common of the linguistic-cognitive symptoms. Most of the children had symptoms from two or three symptom classes, and it seemed that girls had more symptoms than boys. Usually children did not have any comorbid symptoms, or had them from one or three symptom classes. Of the comorbid symptoms the most prevalent ones were problems in activity and attention and neurological symptoms, which consisted mostly of motoric and visuomotoric symptoms. The most common of the comorbid diagnoses was F82, specific developmental disorder of motor function. According to literature children with SLI may have problems in mental health, but the results of this study did not confirm that. Children with diagnosis F80.2 had more linguistic-cognitive and comorbid symptoms than children with diagnosis F80.1. The cluster analyses based on all the symptoms revealed four subgroups of the subjects. Of the subjects 85 percent had a positive family history of developmental disorders, and the most prevalent problem in the families was delayed speech development. This study outlined the symptom profile of children with SLI and laid a foundation for the future longitudinal study. The results suggested that there are differences between linguistic-cognitive symptoms of boys and girls, which is important to notice especially when assessing and diagnosing children with SLI.

Aims. Knowledge of performance in other areas of cognitive processing in children with specific language impairment is contradictory. The aim of this study was to research verbal and cognitive performance as well as intelligence of children with specific language impairment using neuropsychological evaluation data. In addition, the methods used to evaluate neuropsychological processing of the children and their school recommendations were studied. Methods. The participants (N=67) were diagnosed with F80.1 and / or F80.2 in Lastenlinna hospital in 1998-1999 and were neuropsychologically evaluated in 1996 2001. The study retrospectively examined which methods of evaluation were used to assess children with specific language impairment. The participants' test battery scores were gathered. Descriptions of spontaneity, ability to cooperate and concentrate as well as school recommendations were gathered from neuropsychologists' reports. Occurrences of and connections between variables were analyzed with descriptive statistics, graphs, t-tests, chi-square tests, one-way ANOVAs and contrasts. Results and conclusions. The methods used to neuropsychologically evaluate children with specific language impairment in Lastenlinna hospital in 1996 2001 included different versions of Wechsler intelligence scales with which verbal and non-verbal processing were analyzed. In addition, the neuropsychological evaluation was often augmented with the linguistic subtests of Nepsy and Nepsu. The participants performed worse than standard on verbal tasks, whereas in non-verbal tasks their performance was close to standard. Participants with expressive language disorder F80.1 had the verbal IQ close to normal, and only participants with receptive language disorder F80.2 had a significantly low verbal IQ. Children with specific language impairment were mostly recommended to participate in prolonged primary education, full-time special education or general education. The school recommendations were connected to verbal performance: the more severe the problems with language, the more rehabilitating education was recommended. The evaluation of children with specific language impairment should be more comprehensive so that a clearer picture of their cognitive processing and ability to function could be attained. The difference between the verbal and non-verbal performance

Aim. The Verbal Fluency task is one of the naming tasks and it is generally used in clinical neuropsychology and logopedics to investigate for example word retrieval strategies and cognitive flexibility. Previous studies have shown that fluency skills increase strongly as the child grows. So far little is known about the quantitative fluency skills in children under six years of age. The aim of this study is to examine how Finnish-speaking healthy and typically developed children perform a semantic verbal fluency task. The task was divided into six different semantic categories. The aim of the study is to find out whether there is a difference between the performance of 3-year-old, 4-year-old and 5-year-old children, and whether gender has an effect on performance. In addition, the children's performance of the fluency task is compared to their performance in Boston Naming Test and Rapid Automatized Naming Test of pictures and colours to find out whether there is any congruence between the fluency task and the naming tests. Methods. The data was gathered in three different day-care centers in Helsinki from 30 children ages 3 to 5. The children were tested at the day-care centers and their performance was recorded with a dictation machine. Testing was divided into two sections of which the first included the naming tests and the second all the fluency categories. The data was analysed using mainly statistical methods. Results. The results show that age has a significant impact on fluency skills. The largest amounts of correct words were produced by the 5-year-old and the smallest amounts by the 3-year-old children. The older children also made fewer errors than the younger children. All children produced more nouns than verbs. The gender had no impact on the performance in the semantic fluency task, the Boston Naming Test or the Rapid Automatized Naming Test. The results also show some connections between fluency task and naming tests.